Near-falls in people with Parkinson's disease: Circumstances, contributing factors and association with falling

Gazibara, Tatjana; Tepavčević, Darija Kisić; Svetel, Marina; Tomić, Aleksandra; Stanković, Iva; Kostić, Vladimir; Pekmezović, Tatjana

doi:10.1016/j.clineuro.2017.08.008

Cited by 33 publications

(32 citation statements)

References 30 publications

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“…Safe locomotion over uneven terrains requires the ability to adequately avoid obstacles while walking. Tripping over obstacles has been identified as a major cause of falls in PD [11,12] and reductions in foot to obstacle distances, which were observed in PIGD patients only, have been shown to lead to greater number of obstacle contacts during crossing [13]. As such, the observed reductions in foot to obstacle distances in PIGD patients may lead them to a greater risk of tripping and, therefore, may be associated with the greater number of falls reported by these patients (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Objective measures of unobstructed walking and obstacle avoidance in Parkinson’s disease subtypes

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Objective measures of unobstructed walking and obstacle avoidance in Parkinson’s disease subtypes

et al. 2018

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“…Near-falls are open to similar errors of recording; they are events that would result in a fall if protective moves such as reaching out or stepping were not taken. 26 Near-falls among people with Parkinson's have been reported by a number of researchers, such Gazibara et al 89 and Ashburn et al; 37 they are often related to stumbling or balance loss, and have been observed to predispose the general older population to falling. 90 Gazibara et al 89 describe near-falls as common among people with Parkinson's and particularly among people with FoG.…”

Section: Fall Recordingmentioning

confidence: 94%

“…26 Near-falls among people with Parkinson's have been reported by a number of researchers, such Gazibara et al 89 and Ashburn et al; 37 they are often related to stumbling or balance loss, and have been observed to predispose the general older population to falling. 90 Gazibara et al 89 describe near-falls as common among people with Parkinson's and particularly among people with FoG. In this trial, participants received guidance on recording fall events, had a 3-month run-in period for recording falls and received reminders to keep records throughout the trial.…”

Section: Fall Recordingmentioning

confidence: 94%

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Ashburn

Pickering

McIntosh

et al. 2019

Health Technol Assess

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Background People with Parkinson’s disease are twice as likely to experience a fall as a healthy older person, often leading to debilitating effects on confidence, activity levels and quality of life. Objective To estimate the effect of a physiotherapy programme for fall prevention among people with Parkinson’s disease. Design A multicentre, pragmatic, investigator-masked, individually randomised controlled trial (RCT) with prespecified subgroup analyses. Setting Recruitment from NHS hospitals and clinics and community and social services in eight English regions with home-based interventions. Participants A total of 474 people with Parkinson’s disease (i.e. Hoehn and Yahr scale stages 1–4) were recruited: 238 were assigned to a physiotherapy programme and 236 were assigned to usual care. Random allocation was 50 : 50. Interventions All participants received routine care; the usual-care group received an information digital versatile disc (DVD) and a single advice session at trial completion. The intervention group had an individually tailored, progressive, home-based fall avoidance strategy training programme with balance and strengthening exercises: PDSAFE. Main outcome measures The primary outcome was the risk of repeat falling, collected by self-report monthly diaries between 0 and 6 months after randomisation. Secondary outcomes included near-falls, falls efficacy, freezing of gait (FoG), health-related quality of life, and measurements taken using the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Chair Stand Test (CST), the Geriatric Depression Scale, the Physical Activity Scale for the Elderly and the Parkinson’s Disease Questionnaire. Results PDSAFE is the largest RCT of falls management among people with Parkinson’s disease: 541 patients were screened for eligibility. The average age was 72 years, and 266 out of 474 (56%) participants were men. Of the 474 randomised participants, 238 were randomised to the intervention group and 236 were randomised to the control group. No difference in repeat falling within 6 months of randomisation was found [PDSAFE group to control group odds ratio (OR) 1.21, 95% confidence interval (CI) 0.74 to 1.98; p = 0.447]. An analysis of secondary outcomes demonstrated better balance (Mini-BESTest: mean difference 0.95, 95% CI 0.24 to 1.67; p = 0.009), functional strength (CST: p = 0.041) and falls efficacy (Falls Efficacy Scale – International: mean difference 1.6, 95% CI –3.0 to –0.19; p = 0.026) with near-falling significantly reduced with PDSAFE (OR 0.67, 95% CI 0.53 to 0.86; p = 0.001) at 6 months. Prespecified subgroup analysis (i.e. disease severity and FoG) revealed a PDSAFE differing effect; the intervention may be of benefit for people with moderate disease but may increase falling for those in the more severe category, especially those with FoG. Limitations All participants were assessed at primary outcome; only 73% were assessed at 12 months owing to restricted funding. Conclusions PDSAFE was not effective in reducing repeat falling across the range of people with Parkinson’s disease in the trial. Secondary analysis demonstrated that other functional tasks and self-efficacy improved and demonstrated differential patterns of intervention impact in accordance with disease severity and FoG, which supports previous secondary research findings and merits further primary evaluation. Future work Further trials of falls prevention on targeted groups of people with Parkinson’s disease are recommended. Trial registration Current Controlled Trials ISRCTN48152791. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 36. See the NIHR Journals Library website for further project information. Sarah E Lamb is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) at Oxford Health NHS Foundation Trust, the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals NHS Foundation Trust and CLAHRC Oxford. Victoria A Goodwin is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care in the South West Peninsula (PenCLAHRC). Lynn Rochester is supported by the NIHR Newcastle Biomedical Research Centre based at Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University. The research was also supported by the NIHR Newcastle Clinical Research Facility Infrastructure funding. Helen C Roberts is supported by CLAHRC Wessex and the NIHR Southampton Biomedical Research Centre.

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“…PH'de motor bulgulara eşlik eden non-motor bulgulardan kognitif bozukluklar, psikiyatrik bozukluklar, duysal bozukluklar, uyku bozuklukları ve otonom bulgular arasından düşme riski ile ilişkili yapılan prospektif çalışmalarda en fazla incelenen ve düşme için risk faktörü olduğu saptanan bulgu kognitif bozukluk olmuştur (8,15). Depresyon, anksiyete bozukluğu gibi diğer non-motor bulgularla ilişkili sınırlı sayıda ve örneklem sayısı daha kısıtlı olan çalışmalar bulunmaktadır (16,17). Aşırı gündüz uykululuğunun hem genel popülasyonda hem de PH'de düşme riski ile ilişkisi gösterilmiştir (18).…”

Section: Introductionunclassified

Factors Predicting Falls in Parkinson’s Disease: Investigation of Motor, Non-motor Findings and Different Dual Task Activities

Tüfekçıoğlu¹,

Hüseyinsinoğlu²,

Zirek³

et al. 2020

tnd

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Amaç: Bu çalışmada, kognitif bozukluğu olmayan erken-orta evre Parkinson hastalığı (PH) olan hastalarda, düşme için risk faktörü olarak daha önceki çalışmalarda belirlenmiş motor bulgular ile PH'de yürüme hızının ölçülmesinde kullanılan on metre yürüme testine (10MYT) eklenen bellek, basit dikkat ve karmaşık dikkat kognitif çift görev aktivitelerinin ve PH'nin non-motor bulgularının hangilerinin gelecekteki düşmeyi daha iyi tahmin ettireceğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya dahil edilmek üzere 62 kişi değerlendirildi. Dahil edilme kriterlerine uyan 36 kişi çalışmaya alındı. Olguların demografik özellikleri ve klinik bulguları sorgulandı. Motor ve non-motor bulgular Hareket Bozuklukları Derneği Birleşik PH Derecelendirme ölçeği Türkçe versiyonu (HBD-BPDHÖ) ile değerlendirildi. Yürüme hızı 10MYT ve 10MYT'ye eklenen farklı kognitif çift görev aktiviteleri kullanılarak ölçüldü. İlk değerlendirmeden sonra altı ay içindeki düşme hikayesi kaydedildi. Bulgular: Olguların önceki düşme öyküsünün olması, HBD-BPHDÖ 1.A, HBD-BPHDÖ 1.B ve HBD-BPHDÖ 2 skorlarının yüksek olması, 10MYT (tek görev) hızı ile 10MYT bellek, ileri ve geri sayı menzili ve yürütücü işlev çift görev aktiviteleri hızlarının daha düşük olması, altı ay içinde düşme meydana gelmesi ile anlamlı olarak ilişkiliydi (p<0,05). Bu değişkenler kullanılarak yapılan çoklu lojistik regresyon analizi sonucuna göre; hastaların altı ay içinde düşme riskini 10MYT hızındaki artışın 0,76 kat azalttığı, HBD-BPHDÖ 1.B skorundaki artışın 2,06 kat artırdığı görüldü. Sonuç: PH'de düşme ile ilgili bilinen olası risk faktörlerinin bir arada incelendiği çalışmamızda, bilinen kognitif bozukluğu olmayan, erken-orta evre hastaların düşme riskini yürüme hızı ile birlikte non-motor bulgulardan uyku bozukluğu, duysal sorunlar ve otonom bulguların bir arada sorgulandığı HBD-BPHDÖ 1.B skorunun öngördüğü bulunmuştur. Bu bulguların desteklenebilmesi için daha geniş hasta popülasyonunda daha uzun takipli çalışmalar gerekmektedir. Anahtar Kelimeler: Düşme, Parkinson hastalığı, non-motor, çift görev Objective: The purpose of this study was to identify the predictors of future falls in mild-to-moderate stage Parkinson's disease (PD) without cognitive impairment. We evaluated motor findings, non-motor findings, and different cognitive dual tasks such as memory, attention, and executive functions added to the 10-meter walk test (10MWT), which has been used to measure walking speed in PD. Materials and Methods: A total of 62 subjects were evaluated in terms of eligibility for the study. Thirty-six patients with PD who met the inclusion criteria were included in the study. Demographic characteristics were identified and clinical findings were examined. Motor and non-motor findings were evaluated using the Turkish version of the Movement Disorder Society-Unified PD Rating scale (MDS-UPDRS). Walking speed was measured with the 10MWT as single task and with different cognitive domains added to the 10MWT as cognitive dual task activities. After the initial evaluation, falls wit...

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Near-falls in people with Parkinson's disease: Circumstances, contributing factors and association with falling

Cited by 33 publications

References 30 publications

Objective measures of unobstructed walking and obstacle avoidance in Parkinson’s disease subtypes

Objective measures of unobstructed walking and obstacle avoidance in Parkinson’s disease subtypes

Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson’s: the PDSAFE RCT

Factors Predicting Falls in Parkinson’s Disease: Investigation of Motor, Non-motor Findings and Different Dual Task Activities

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